Lung Cancer. 2016 Apr;94:7-14. doi: 10.1016/j.lungcan.2016.01.010. Epub 2016 Jan 21.

The role of new PET tracers for lung cancer.

Szyszko TA1, Yip C2, Szlosarek P3, Goh V4, Cook GJ5.

Author information

• 1King's College London and Guy's & St. Thomas' PET Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, London SE1 7EH, UK; Department of Cancer Imaging, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
• 2King's College London and Guy's & St. Thomas' PET Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, London SE1 7EH, UK; Department of Cancer Imaging, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK; Department of Radiation Oncology, National Cancer Centre Singapore 169610, Singapore.
• 3Lung and Mesothelioma Unit, Department of Medical Oncology, KGV Basement, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.
• 4Department of Cancer Imaging, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK; Radiology Department, Guys & St. Thomas' NHS Trust, London SE1 7EH, UK.
• 5King's College London and Guy's & St. Thomas' PET Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, London SE1 7EH, UK; Department of Cancer Imaging, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK. Electronic address: gary.cook@kcl.ac.uk.

Abstract

18F-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET/CT) is established for characterising indeterminate pulmonary nodules and staging lung cancer where there is curative intent. Whilst a sensitive technique, specificity for characterising lung cancer is limited. There is recognition that evaluation of other aspects of abnormal cancer biology in addition to glucose metabolism may be more helpful in characterising tumours and predicting response to novel targeted cancer therapeutics. Therefore, efforts have been made to develop and evaluate new radiopharmaceuticals in order to improve the sensitivity and specificity of PET imaging in lung cancer with regards to characterisation, treatment stratification and therapeutic monitoring. 18F-fluorothymidine (18F-FLT) is a marker of cellular proliferation. It shows a lower accumulation in tumours than 18F-FDG as it only accumulates in the cells that are in the S phase of growth and demonstrates a low sensitivity for nodal staging. Its main role is in evaluating treatment response. Methionine is an essential amino acid. 11C-methionine is more specific and sensitive than 18F-FDG in differentiating benign and malignant thoracic nodules. 18Ffluoromisonidazole (18F-FMISO) is used for imaging tumour hypoxia. Tumour response to treatment is significantly related to the level of tumour oxygenation. Angiogenesis is the process by which new blood vessels are formed in tumours and is involved in tumour growth and metastatic tumour spread and is a therapeutic target. Most clinical studies have focused on targeted integrin PET imaging of which αvβ3 integrin is the most extensively investigated. It is upregulated on activated endothelial cells in association with tumour angiogenesis. Neuroendocrine tumour tracers, particularly 68Ga-DOTA-peptides, have an established role in imaging of carcinoid tumours. Whilst most of these tracers have predominantly been used in the research environment, they offer exciting opportunities for improving staging, characterisation, stratification and response assessment in an era of increased personalised therapy in lung cancer.